Change of Address/Name
Licensees of the North Carolina Medical Board are required to keep a current address and/or name on file with the Board (private information such as home address will not be released to the public).
Change of address for ACTIVE physicians and physician assistants
If you are a physician or physician assistant with an active license, you may change your address online. Click on the Address Change form at right to log in to your Licensee Information Page. Select “Address” to update your home or practice address.
Change of address for other license types
Anesthesiologist assistants, clinical pharmacist practitioners and licensed perfusionists must submit paper address change forms at this time. Download the form here and mail or fax it to the Board’s office. It is not necessary to do both. Licensees will receive an updated copy of their certificate via email, if a valid email dress is provided to the Board.
Changing your name
Licensees who experience a name change are asked to advise the Board of the change within 30 days. At this time, the Board accepts paper name change forms. Click “Name Change Form” at right to begin.